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Endodontide ağrı ve analjezik kullanımı

Pain and analgesic use in endodontic

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Abstract (2. Language): 
Dental pain is an undesirable situation for both the clinician and the patient. Clinician should overcome this discomfortable situation. Understanding of the pain system, a good endodontic dental procedure and the use of appropriate analgesics are important steps in management of dental pain. Pain system starting with the signal detection of tissue damage in the periphery, ongoing processing of data at the level of the spinal cord, perceived at the high brain regions such as cerebral cortex is a multilevel and complex system. A clinician who understands all levels of the pain system basically can perform effective methods of pain control by getting the opportunity of using therapeutics. In pulp, thin C and small Aδ fibers have a role for the pain perception. Non-narcotic and narcotic analgesics are prefered to manage endodontic pain. Acetaminophen and non-steroidal antiinflammatory drugs or opioid analgesics and combinations of these drugs are frequently used in endodontic pain management. In this review information will be given about the mechanism of endodontic pain, transmission paths and analgesics used for pain management.
Abstract (Original Language): 
Dental ağrı hem hekim hem de hasta için istenmeyen bir durumdur. Hekim bu durumun üstesinden gelebilmelidir. Ağrı sisteminin anlaşılması, iyi bir endodontik prosedür ve uygun analjeziklerin kullanımı dental ağrının kontrolünde önemli adımları oluşturmaktadır. Ağrı sistemi, periferde doku hasarı yapan uyaranın tespiti ile başlayan, verinin omurilik düzeyinde işlenmesiyle devam eden, serebral korteks gibi yüksek beyin bölgelerinde algılanan, çok seviyeli ve kompleks bir sistemdir. Temel olarak ağrı sisteminin her seviyesini anlayan bir klinisyen, terapötikleri kullanma fırsatını yakalayarak etkili ağrı kontrol Metotlarını uygulayabilir. Pulpada ağrının algılanmasında ince C ve küçük Aδ fibrilleri rol oynar. Narkotik ve non-narkotik analjezikler endodontik ağrıyı yönetmek için tercih edilir. Endodontik ağrının yönetiminde asetaminofen ve non-steroid antiinflamatuar ilaçlar veya opioid analjezikler ile bu ilaçların kombinasyonları sıklıkla kullanılmaktadır. Bu derlemede endodontik ağrı mekanizması, iletim yolları ve ağrı yönetimi için kullanılabilecek analjezikler hakkında bilgi verilecektir.
FULL TEXT (PDF): 
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REFERENCES

References: 

1. Keiser K ve Byrne BE. Endodontic pharmacology.
Hargreaves KM, Cohen Stephen, ed. Pathways of
the pulp. St. Louis, Missouri: Elsevier, 2011: 671-
690.
2. Byers MR, Narhi MV. Dental injury models:
experimental tools for understanding
neuroinflammatory interactions and polymodal
nociceptor functions. Crit Rev Oral Biol Med.
1999; 10: 4-39.
3. Johnsen DC, Harshbarger J, Rymer HD.
Quantitative assesment of neural development in
human premolars. Anat Rec 1983; 205: 421-429.
4. Trowbridge HO. Review of dental pain-histology
an physiology. J Endod. 1986; 12: 445-452.
5. Fehrenbacher J, Sun XX, Locke E, Henry M.
Hargreaves KM. Capsaicin-evoked ICRP release
from human dental pulp: a model system for the
study of peripheral neuropeptide secretion in
normal healthy tissue. Pain 2009; 144: 253-261.
6. Guyton AC, Hall JE. Textbook of Medical
Physiology, 10 th ed. Philadelphia: WB. Saunders
Company, 2001.
7. Byers MR, Taylor PE, Khayat BG, and Kimberley
CL. Effects of injury and inflamation on pulpal and
periapical nerves. J Endod 1990; 16: 78-84.
8. Fried K and Risling M. Nerve growth factor
receptor-like immunoreactivity in primary and
permanent canine tooth pulps of the cat. Cell
44
Endodontide Ağrı ve Analjezik Kullanımı
Bulem Ureyen Kaya ve ark.
Tissiue Res 1991; 264: 321-328.
9. Goodies HE, Bowles WR, and Hargreaves KM.
Prostaglandin E2 enhances bradykinin-evoked
İCGRP release in bovine dental pulp. J Dent Res
2000; 79: 1604-1607.
10. Chang MC, Chen YJ, Tai TF, Tai MR, Li MY, Tsai
YL, Lan WH, Whang YL, Jeng JH. Cytokineinduced
prostaglandin E2 production and
cyclooxygenase-2 expression in dental pulp cells:
Downstream calcium signalling via activation of
prostaglandin EP receptor. Int Endod J 2006; 39:
819-826.
11. Nakanishi T, Matsuo T, and Ebisu S. Quantitative
analysis of immunoglobulins and inflammatory
factors in human pulpal blood from exposed pulps.
J Endod 1995; 21: 131-136.
12. Shimauchi H, Takayama S, Miki Y, Okada H. The
change of periapical exudate prostaglandin E2
levels during root canal treatment. J Endod 1997;
23: 755-758.
13. Wheeler EF, Naftel JP, Pan M, von Bartheld CS,
Byers MR. Neurotrophin receptor expression is
induced in a subpopulation of trigeminal neurons
that label by retrograde transport of NGF or fluorogold
following tooth injury. Brain Res Mol Brain
Res 1998; 61: 23-38.
14. Lepinski AM, Hargreaves KM, Goodies HE,
Bowles WR. Bradykinin levels in dental pulp by
microdialysis. J Endod 2000; 26: 744-747.
15. Hargreaves KM, Milam SB. Mechanisms of pain
and analgesia. In: Dionne R, Phero J. Management
of pain and anxiety in dental practice, New York:
Elsevier, 2001; 18-40.
16. Keiser K, Hargreaves K. Building effective
strategies for the management of endodontic pain.
Endod Topics 2002; 3: 93-105.
17. Sessle B. Recent developments in pain research:
central mechanisms of orofacial pain and its
control. J Endodon 1986; 12: 435-444.
18. Dallel R, Clavelou P, Woda A. Effects of tractotomy
on nociceptive reactions induced by tooth pulp
stimulation in the rat. Exp Neurol 1989; 106: 78-
84.
19. Marriott D, Wilkin GP, Coote PR, Wood JN.
Eicosanoid synthesis by spinal cord astrocytes
is evoked by substance P; possible implications
for nociception and pain. Adv Prostaglandin
Thromboxane Leukot Res. 1991; 21B: 739-741.
20. Seesle BJ, Hu JW, Amano N, Zhong G.
Convergence of cutaneous, tooth pulp, visceral,
neck and muscle afferents onto nociceptive
and non-nociceptive neurones in trigeminal
subnucleus caudalis (medullary dorsal horn) and
its implications for referred pain. Pain 1986; 27:
219-235.
21. Bunczak-Reah M, Hargreaves K. Effect of
inflammation on delivery of drugs to dental pulp. J
Endod. 1998; 24: 822-825.
22. Dionne RA. Additive analgesic effects of
oxycodone and ibuprofen in the oral surgery
model. J Oral Maxillofac Surg. 1999; 57: 673-679.
23. Hargreaves K, Troullos E, Dionne R.
Pharmacologic rationale for the treatment of acute
pain. Dent Clin North Am. 1987; 31: 675-694.
24. Hargreaves KM, Keiser K. New advances in the
management of endodontic pain emergencies. J
Calif Dental Assoc. 2004; 32: 469-473.
25. Kayaalp O. Rasyonel tedavi yönünden Tıbbi
Farmakoloji, 12 th ed. Ankara: Pelikan Yayınları,
2009; 837-870.
26. Doroschak AM, Bowles WR, Hargreaves KM.
Evaluation of the combination of flurbiprofen and
tramadol for management of endodontic pain. J
Endod 1999; 25: 660-663.
27. Holstein A, Hargreaves KM, Niedeiman R.
Evaluation of NSAIDs for treating post-endodontic
pain. Endod Topics 2002; 3: 3-13.
28. Hashioka K, Yamakasi M, Nakane A, Horiba N,
Nakamura H. The relationship between clinical
symptoms and anaerobic bacteria from infected
root canals. J Endod 1992; 18: 558-561.
29. Siqueira JF, Rocas IN, Rosado AS. Investigation
of bacterial communities associated with
asymptomatic and symptomatic endodontic
infections by denaturing gradient gel
electrophoresis fingerprinting approach. Oral
Microbiol Immunol 2004; 19: 363-370.
30. Sedgley CM, Molander A, Flannagan SE, Nagel
AC, Appelge OK, Clewell DB, Dahlen G.
Virulence, phenothype and genotype characteristics
of endodontic Enterococcus spp. Oral Microbiol
Immunol 2005; 20: 10-19.
31. Reynaud af Geijersstam A, Culak R, Molenaar L,
Chattaway M, Roslie E, Peciuline V, Haapasalo
M, Shah HN. Comparative analysis of virulence
determinants and mass spectral profiles of Finish
and Lithuaninan endodontic Enterococcus faecalis
isolates. Oral Microbial Immunol 2007; 22: 87-94.
45
Endodontide Ağrı ve Analjezik Kullanımı
Bulem Ureyen Kaya ve ark.
32. O’Neill LA. Immunology after the toll rush.
Science 2004; 303: 1481-1482.
33. Wadachi R, Hargreaves KM. Trigeminal
nociceptors express TLR-4 and CD 14: A
mechanism for pain due to infection. J Dent Res
2006; 85: 49-53.
34. Baumgartner JC, Falkler WA, Jr. Biosynthesis of
IgG in periapical lesion explant cultures. J Endod
1991; 17: 143-146.
35. Hahn CL, Best AM, Tew JG. Cytokine induction
by Streptococcus mutans and pulpal pathogenesis.
Infect Immun 2000; 68: 6785-6789.
36. Poltorak A, He X, Smirnova I, Liu MY, Van Huffel
C,Du X, Birdwell D, Alejos E, Silva M, Galanos
C, Freudenberg M, Ricciardi-Castagnoli P , Layton
B, Beutler B. Defective LPS signaling in C3 H/HeJ
and C57 BL/10ScCr mice: Mutations in Tlr4 gene.
Science 1998; 282: 2085-2088.
37. Qi HY, Shelhamer JH. Toll-like receptor 4 signaling
regulates cytosolic phospholipase A2 activation
and lipid generation in lipopolysaccharidestimulated
macrophages. J Biol Chem 2005; 280:
38969-38975
38. Dionne R. Suppression of dental pain by the
preoperative administration of flurbiprofen. Am J
Med Sci 1986; 80: 41-49.
39. Arnold J, Salom I, Berger A. Comparison of
gastrointestinal microbleeding associated with
use of etodolac, ibuprofen, İndomethacin, and
naproxen in normal subjects. Curr Ther Res 1985;
37: 730-738.
40. Cooper S, Berrie R. Cohn P. The analgesic efficacy
of ketoprofen compared to ibuprofen and placebo.
Adv Ther 1988; 5: 43-53.
41. Dionne R. COX-2 inhibitors: better than ibuprofen
for dental pain? Compendium 1999; 20: 518-524.
42. Khan AA, Dionne AA. The COX-2 inhibitors: new
analgesic and anti-inflammatory drugs, Dent Clin
North Am 2002; 46: 679-690.
43. Ehrich EW, Dallob A, De Lepeleire I, Van Hecken
A, Riendeau D, Yuan W, Porras A, Wittreich J,
Seibold JR, De Schepper P, Mehlisch DR, Gertz BJ.
Characterization of rofecoxib as a cyclooxygenase
inhibitor and demonstration of analgesia in the
dental pain model. Clin Pharmacol Ther 1999; 65:
336-347.
44. Nakanishi T, Sbimuzu H, Matsu O
T. Immunohistochemical analysis of
cyclooxygenase-2 in human dental pulp. J Dent
Res 1999; 78: 142.
45. Bombardier C, Laine L, Reicin A, Shapiro D,
Burgos-Vargas R, Davis B, Day R, Ferraz MB,
Hawkey CJ, Hochberg MC, Kvien TK, Schnitzer
TJ; VIGOR Study Group. Comparison of upper
gastrointestinal toxicity of rofecoxib and naproxen
in patients with rheumatoid arthritis. VIGOR Study
Group. N Engl J Med. 2000; 343: 1520-1528.
46. Byrne B. Drug interactions: a review and update.
Endod Topics 2003; 4:9-21.
47. Cooper S. Treating acute dental pain. Postgrad
Dent. 1995; 2: 7-14.
48. Gage T, Pickett F. Mosby’s Dental Drug Reference,
4 th ed. St Louis: Mosby, 2001.
49. Wynn R, Meiller T, Crossley H. Drug Information
Handbook for Dentistry, 9th ed. Ohio: Lexi-Comp
Inc, 2003.
50. Dionne RA, Berthold C. Therapeutic uses of nonsteroidal
anti-inflammatory drugs in dentistry. Crit
Rev Oral Biol Med. 2000; 12: 315-330.
51. Cooper S. New peripherally acting oral analgesics.
Annu Rev Pharmacol Toxicol. 1983; 23: 617-647.
52. Kis B, Snipes A, Bari F, Nusija DW. Regional
distribution of cyclooxyfenase-3 mRNA in the rat
central nervous system. Brain Res Mol Brain Res
2004; 126: 78-80.
53. Menhinick KA, Gutmann JL, Regan JD, Taylor
SE, Buschang PH. The efficacy of pain control
following nonsurgical root canal treatment using
ibuprofen or a combination of ibuprofen and
acetaminophen in a randomized, double-blind,
placebo-controlled study. Int Endod J 2004; 37:
531-541.
54. Dionne RA, Lepinski AM, Gordon SM, Jaber L,
Brahim JS, Hargreaves KM. Analgesic effects
of peripherally administered opioids in clinical
models of acute and chronic inflammation. Clin
Pharmacol Ther. 2001; 70: 66-73.
55. Hargreaves K, Joris . The peripheral analgesic
effects of opioids. J Am Pain Soc. 1993; 2: 51-59.
56. Troullos E, Freeman H, Dionne R. The scientific
basis for analgesic use in dentistry. Anesth Pro.
1986; 33: 123-138.
57. Beaver W. Mild analgesics. A review of their
clinical pharmacology. Am J Med Sci 1966; 251:
576-579.

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